The Effect of Early Passive Range of Motion Exercise on Motor Function of People with Stroke: a Randomized Controlled Trial.

Nursing Care Research Centre, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.

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Department of Statistics, School of Health, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Frequent and regular exercises in the first six months of stroke may cause return of a significant portion of sensory and motor function of patients. This study aimed to examine the effects of passive range of motion exercise in the acute phase after stroke on motor function of the patients. Methods: A randomized controlled trial study was conducted. The patients with first ischemic stroke were randomly allocated to either experimental (n=33) or control (n=19) group. Passive range of motion exercises was performed in the experimental group during the first 48 hours of admission as 6 to 8 times of 30 minute exercise. Before intervention, and one and three months after intervention, motor function were measured by muscle strength grading scale (Oxford scale) and compared. SPSS version 13.0 for Windows was used for statistical analysis. Frequency distribution was used to describe the data. For comparisons, paired t-test, independent t-test was used, and repeated measures test was used. Results: In acute phase, the intervention in the experimental group led to significant improvement of motor function between the first and third month in both the upper and lower extremities. In control group, improvement was observed only in the muscle strength of upper extremity in the first and third month compared to pre-intervention measurement. The greatest improvement was observed in the interval from base to one month in the upper extremity, and base to the first month and the first to the third month in the lower extremity. Conclusion: It is recommended to use early passive range of motion exercise as part of care for people with stroke during the acute phase of the disease.

Exercise was tailored to each person's health status and in some cases, each turn was different. In the control group, only the routine therapeutic program was implemented and motor function assessment was achieved in the time intervals similar to those of the experimental group. Motor function of patients in the experimental and control groups were measured at the end of the first month after the exercises, and then three months later by the same researcher. The steps of the study are shown in .

depicts the motor function of upper and lower extremities in the experimental and control groups. One and three months after the intervention, the mean scores for motor function of the upper and lower extremities in the experimental group was higher than that of the control group, but the difference was not statistically significant. Therefore, we examined if the changes in motor function of the groups are different. A comparison of the groups in terms of changes in the motor function during the first month after the intervention showed that the upper extremity muscle strength in the experimental group improved more than that in the control group 1.09 (0.84) vs. 0.58 (0.90), P=0.045 (). Also, for lower extremity, the muscle strength in the experimental group improved more than that in the control group during the first month after the intervention 0.76 (0.71) vs. 0.00 (1.11), (P=0.004). As shown in , changes in motor function of both upper and lower extremities were not statistically significant between the experimental and control groups three months after the intervention and within the time period of the first and third month after the intervention. Our findings seem to suggest that the intervention in the acute phase after stroke improved motor function in both upper and lower extremities, one month after intervention. It is important to note that, we found a statistically significant improvement, through within-group comparisons, in the upper extremity motor function of the control group, one month (P= 0.012) and three months after the intervention (P=0.004) relative to the basement measurement. This finding shows that part of the improvement in the motor function of the experimental group might well be attributed to time rather than the intervention ( and ).

depicts the motor function of upper and lower extremities in the experimental and control groups. One and three months after the intervention, the mean scores for motor function of the upper and lower extremities in the experimental group was higher than that of the control group, but the difference was not statistically significant. Therefore, we examined if the changes in motor function of the groups are different. A comparison of the groups in terms of changes in the motor function during the first month after the intervention showed that the upper extremity muscle strength in the experimental group improved more than that in the control group 1.09 (0.84) vs. 0.58 (0.90), P=0.045 (). Also, for lower extremity, the muscle strength in the experimental group improved more than that in the control group during the first month after the intervention 0.76 (0.71) vs. 0.00 (1.11), (P=0.004). As shown in , changes in motor function of both upper and lower extremities were not statistically significant between the experimental and control groups three months after the intervention and within the time period of the first and third month after the intervention. Our findings seem to suggest that the intervention in the acute phase after stroke improved motor function in both upper and lower extremities, one month after intervention. It is important to note that, we found a statistically significant improvement, through within-group comparisons, in the upper extremity motor function of the control group, one month (P= 0.012) and three months after the intervention (P=0.004) relative to the basement measurement. This finding shows that part of the improvement in the motor function of the experimental group might well be attributed to time rather than the intervention ( and ).